Prevention of low backache in pregnancy

To document the effect of back care advice on the frequency and severity of low backache in pregnancy. Comparative cross sectional study. This study was conducted in Antenatal Outpatient department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar from Jan 2012 to Jun 2012. Advice on back care was made available to a group of primigravidae women as early in their pregnancy as possible. For comparison another group of primigravidae women for which no such advice was given was recruited. Both groups were followed throughout pregnancy for the occurrence of low back pain and its severity. The study comprised of 200 primigravidae with 100 women each in study group and control group. Seventy eight women in study group and 65 in the control group reached term. Among the study group 28.2 % experienced low backache in contrast to control group in which 56.9% developed back pain during pregnancy. In the study group 68.1% were having mild, 27.2 % moderate and only 4.5% severe pain. In the control group majority of women experienced moderate to severe pain. Furthermore the study group had pain much later in gestation as compared to control group. Low backache was less common inprimigravidae women who receive advice on back care early in pregnancy. Low back pain, if present was less troublesome and severe than pregnant women for whom no such advice was available

Risk factors and management of birth related femoral fracture

To evaluate the risk factors and management of femoral fractures related to birth trauma. , Descriptive Case series Study. This study was conducted in Department of Orthopaedics and Traumatologyand Department of Obstetrics and Gynecology of Khyber Teaching Hospital, Peshawar from April 2008 to March 2013. Over a period of 5 years,cases of femoral fractures in newborns due to birth trauma presenting to Orthopaedic and aumatologydepartment or occurring in Obstetrics and GynecologyDepartment of Khyber Teaching Hospital Peshawar were recruited to the study. Birth histories of the cases were explored with respect to period of gestation, birth weight, presentation at birth and mode of delivery.Type of fracture and management used was documented. Cases were followed till recovery. Mean gestational age was 38.1 weeks and mean time to diagnose was 3 days. Presentation of baby was breech and mode of delivery was Caesarean section in majority of cases.Mid shaft fracture was present in ten cases and three had subtrochanteric fracture. All patients showed complete union at a mean duration of 3.2 weeks. Femoral fracture due to birth trauma in newborn is a rare injury. It is more common in cases of Caesarean section done for breech presentation. Risk is high in preterm and/or low birth weight babies. Fracture mostly involves shaft of femur.These fractures have very good prognosis and show complete healing following immobilization

To determine the frequency of modes of delivery in short-statured primigaravidae at term

The aim of this study was to determine the frequency of modes of delivery in short-statured primigaravidae at term. Descriptive cross sectional study. This study was conducted in the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, Peshawar, from Apr 2010 to Mar 2011. 369 primigravidae,15-35 years old with singleton pregnancy, cephalic presentation and with height less than 152 cm were randomized for the study. Pelvic assessment was done clinically in all and radiologically in some cases. Monitoring of labour was done and modes of deliveries were recorded. Mean age and height was 25.57years + 3.22SD and 148.9cm + 2.1SD respectively. Normal vaginal delivery occured in 96[26.02%] while 32[8.67%] patients had instrumental vaginal delivery [13 [3.52%] vacuum and 19 [5.15%] outlet forceps]. Elective and emergency cesarean section was done in 28 [7.59%] and 207[56.09%] patients respectively. Primigravidae with short stature constitutes a high risk group for poor progress in labour. Emergency cesarean section is more common in short statured primigravidae

relationship between developmental dysplasia of hip and mode of delivery in term-breech-neonate

To investigate the relationship between developmental dysplasia of the hip and mode of delivery in term breech neonates. Prospective Cohort Study. This study was conducted in Khyber Teaching Hospital Peshawar from May 2012 to April 2013. Over the study period all neonates delivered at term as singleton breech in the Obstetrics and Gynecology department of Khyber Teaching Hospital were included in the study. Period of gestation, parity, and mode of delivery, fetal gender and birth weight of each neonate was recorded. All neonates were assessed for DDH both clinically and through ultrasound. Severity of dysplasia was graded using modified Graf's static morphological method. Correlation was made between DDH and mode of delivery. Mode of delivery was categorized as vaginal delivery, emergency cesarean section and elective cesarean section. There were a total of 283 breech deliveries during the study period, out of which 16 had DDH. Incidence was more in primigravidae. Majority were females. DDH was more common in vaginally delivered breech babies, in majority of whom DDH was more severe [Graf type III and IV, as opposed to babies delivered through elective cesarean section. Vaginally delivered breech babies constitute a high risk group for DDH. Clinical examination followed by ultrasound examination of both hip joints should be undertaken in all babies delivered as breech so as to institute management in time to prevent avascular necrosis of femoral head

Birth related Erb's Palsy: obstetrical correlates and outcome

This study aims to determine the obstetrical correlates and outcome of birth related Erb's palsy. Retrospective cohort study. This study was conducted in Obstetrics and Gynecology and Orthopedics and Traumatology Departments of Khyber Teaching Hospital Peshawar from Dec 2004 to Nov 2009. Hospital records from Dec 2005 to Nov 2010 were searched. A cohort of all cases of birth related Erb's palsy over a 5 year period was recorded. Birth records of cases were obtained. Cases were contacted and called for followup and assessment of functional outcome from Jan through March 2013. a total of 30, 367 live births were recorded during the study period out of which there were 28 cases of obstetrical Erb's palsy. Their birth records revealed that 27 were delivered vaginally and only 1 through cesarean section. In 17 cases delivery was complicated by shoulder dystocia out of which 10 mothers were diabetic. Mean weight at birth was 3.8 kg. All cases were managed conservatively. Twenty five cases presented for follow up. Twenty cases had no residual functional deficit. Five children had some form of functional deficit present. Erb's palsy is seen more commonly in births complicated by shoulder dystocia and in diabetic mothers with high birth weight babieds. Conservative management is effective but regular follow up is needed to pick up those cases that require surgical intervention to prevent lifelong handicap

Prevalence of vitamin D inadequacy among postmenopausal women

To evaluate serum vitamin D levels and factors related to vitamin D inadequacy in postmenopausal women. Observational Cross-sectional study. This study was conducted in Outpatient departments of Obsetrics and Gynaecology and Orthopedics and Traumatology, Khyber Teaching Hospital, Peshawar from Dec 2011 to No 2012. During the study period, 200 postmenopausal women presenting to Orthopedics and Gynecology outpatient departments of Khyber Teaching Hospital were randomly recruited to the study. Women with active liver and/ or kidney disease and those taking drugs affecting calcium and vitamin D metabolism were excluded from the study. Serum Vitamin D levels were analyzed and were categorized as adequate [more than 30 ng/ml], insufficient [20-30 ng/ml], mild deficiency [10-20 ng/ml], moderate [5-10 ng/ml] and severe [<5 ng/ml]. The study included 200 postmenopausal women. Mean age was 58 years with a mean BMI of 24.3 kg/m[2]. Mean Vitamin D levels were 14.7 ng/ml with a range of 4-62 ng/ml. Vitamin D deficiency was present in 59% of postmenopausal women. Thirty three percent had mild deficiency while 21% had moderate deficiency. Five percent of women were severely deficient. More than half of postmenopausal women in our province have vitamin D deficiency underscoring the need for vitamin D supplementation in this vulnerable population. Prevention and early detection of hypovitaminosis D is the key to reduce the incidence of osteoporosis among postmenopausal women

Out patient medical management of anembryonic pregnancy using misoprostol

This study aims to evaluate the efficacy, safety and acceptability of misoprostol for outpatient management of anembryonic pregnancy. This was a prospective observational study. This study was conducted in the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital Peshawar from Dec. 2011 to Nov. 2012. Over a study period of one year 100 women attending our unit with ultrasound proven anembryonic pregnancy of < 10 weeks' gestation and opting to have medical management and consented to have it on an outpatient basis were recruited for the study. All patients were given 800 micro g of misoprostol intra-vaginally in the unit and advised to take two further doses of 400 micro g of misoprostol, orally, 3 hours apart, the following day at home. Outcome measures included success rates, emergency admission rates, pain scores, satisfaction level, incidence rates of side - effects and number of women who would choose medical management in future. Of the 100 women with anembryonic pregnancy, over three - quarters [n = 88, 88%] of the women achieved successful complete medical evacuation. Overall 6 [6%] women presented for emergency admission. Eighty eight patients were satisfied with the management. The mean visual analogue scale [VAS] score of all women was 6.9. Eighty seven said that they would choose to have medical evacuation in a future miscarriage. A total of 85 women said they would prefer to have the treatment at home rather than in the hospital. No serious side effect was reported with misoprostol. It was concluded that medical evacuation of anembryonic pregnancy is effective, safe and acceptable in the outpatient setting

Effectiveness of platelete rich plasma [PRP] injections in patients with plantar fasciitis

To determine the effectiveness of PLATELETE RICH PLASMA [PRP] injection in patients with plantar fasciitis interms of improvement in at least one grade of pain on visual analogue scale at 6 weeks interval follow up. Descriptive cross sectional study. This study was conducted in Orthopedics Unit of Khyber Teaching Hospital, Peshawar from March, 2012 to Feb 2013. Patients with plantar fasciitis from the age of 20 to 50yearswho were not responding to oral medications were included in the study. There were 26 [9.38%] males and 38 [59.38%] females with mean age of 37.00 years. 45.31% patients have symptoms for 6-12 weeks where as those who had symptoms for 13-26 weeks made 48.43%of the study population. A total of 43[67.18%] patients having moderate pain before PRP only had severe pain at 6 weeks, while 25 [39.06%] had no pain, 13 [20.31%] had mild pain and 4 [6.25%] had moderate pain. Out of 21 [32.81%] patients who had severe pain before PRP, 36 [56.25%] had no pain, 18 [28.12%] had mild and 9 [14.06%] had moderate pain. Nonetheless, 3 [4.69%] had severe pain even after PRP. Over all, PRP was equally effective in patients of all ages and was more effective in men. Platelet Rich Plasma which is cheap and effective can successfully treat patients with plantar fasciitis

Conservative management of proximal fifth metatarsal fractures [Jones fracture]

To determine the outcome of proximal fifth metatarsal fracture treated by POP [Plaster of Paris] cast. Descriptive Cross -sectional study. This study was conducted in the Department of Orthopaedics and Traumatology of KhyberTeaching Hospital, Peshawar from Jan 2012 to Jan 2013. Hundred patients with fracture of proximal fifth metatarsal bone [Jones fracture] were managed conservatively with plaster cast immobilization. Fracture healing and functional outcome was assessed. The mean age of the patients was 53 years. The clinical and radiological union rates at 6 months of follow up were 97% and 95.3% respectively. A progressive improvement in AOFAS [American Orthopaedic Foot and Ankle Society] mid foot scale score was seen. Overall 92% patients were satisfied with theoutcome.Four patients had malunion and only one had nonunion. Acute fracture of proximal fifth metatarsal can be effectively managed by plaster cast immobilization

Carpal tunnel syndrome in pregnancy

To determine the frequency, severity and prognosis of carpal tunnel syndrome [CTS] in pregnancy. Descriptive Cross -sectional study Place and duration of Study: This study was conducted in Gynae [B] Unit of Khyber Teaching Hospital, Peshawar from Apr 2012 to Mar 2013. During the study period, pregnant women presenting to Antenatal Outpatient Department of Gynae B unit were randomly assessed for carpal tunnel syndrome. If present, severity of CTS and its relation to age, trimester of pregnancy, weight gain during pregnancy, parity and any underlying medical problem was made. Treatment was advised and response to treatment was assessed. Patients were followed up for outcome. Of 1000 Pregnant women assessed, 22.3% had symptoms and signs suggestive of CTS. Bilateral [68%] paresthesia [82%] and pain [60%] in third trimester of pregnancy were the most frequent presenting symptoms. It was more common in >30 years old mutigravidae and with a weight gain in pregnancy of more than 15kg. Majority [95%] of patients responded to splinting of wrist at night. Carpal tunnel syndrome is common during third trimester of pregnancy especially in mutigravidae who gain more weight during pregnancy and are above 30 years of age. CTS severe enough to warrant surgical treatment occurs infrequently in pregnancy and generally responds to conservative treatment

External fixation: daily versus weekly pin site care

To determine whether there were any differences in the frequency and severity of pin site infections by performing pin site care daily or once a week. cross sectional descriptive study. This study was carried out at Department of Orthopaedics and Traumatology, Khyber Teaching Hospital, Peshawar during the period from Dec 2011 to Jun 2013. This study included 96 patients who were selected by convenient [non probability] sampling technique. Patients were divided into two groups. The mean infection rate during the study in group 1 was grade I in 16% and grade II in 7%, grade III in 1% versus grade I in 12% and grade II in 5%, grade III in 5% in group 2. No grade IV-VI infections were noted. Antibiotics were prescribed for a mean of 60 days [SD 15] in group 1 and 45 days [SD 30] in group 2. The relative risk [RR] of positive cultures at the proximal pin sites was 1.5 [95% CI 1.2-1.9] No difference was found between the groups. No differences between daily and weekly pin site care were observed as regards the severity of infections, frequency of infection rate, of positive cultures, except in week 6, and in use of antibiotics or analgesics

Three monthly intravenous injections of ibandronate in the treatment of postmenopausal osteoporosis

Osteoporosis is a chronic condition that generally requires long-term therapy for fracture risk reduction to become apparent. Bisphosphonates are important therapeutics in postmenopausal Osteoporosis. However, they are currently associated with stringent dosing instructions that may impair patient compliance and hence therapeutic efficacy. Intravenous [IV] treatment with an aminobisphosphonate, pamidronate was effective, but required infusions. Ibandronate, a new very potent aminobisphosphonate, can be administered safely as an IV bolus injection, and therefore offers an interesting alternative suitable for outpatient treatment. To determine the effectiveness of three monthly IV boluslbandronate injections in terms of increase in bone mineral density at hip and spine in postmenopausal women. Randomized Placebo controlled study. This study was conducted in Gynae [B] Unit of Khyber Teaching Hospital, Peshawar from Feb 2012 to Jan 2013 150ambulatory Postmenopausal women 55-75 years old, and atleast 5years since menopause with Osteoporosis [[bone mineral density [BMD] < -2.5 SD T score] received a placebo or IbandronatelV bolus injection [3 mg] every 3 months. All patients received 1 g calcium/day. BMD, expressed in T score, was measured by dual-energy x-ray absorptiometry [DEXA] at lumbar spine and hip. Exclusion criteria were a disease, disorder, or therapy [within the last 6 months] known to influence bone metabolism; prior treatment with oral or intravenous bisphosphonates; Baseline radiographic assessment for prevalent vertebral fractures was not performed in this study. All participants provided written informed consent. There were 150 Postmenopausal women with mean age of 62 years.Lumbar spine BMD [L2 to L4] decreased by 2.9% and hip by 3.2% in the placebo group, but increased by 5.2% at 12 months for Ibandronategroup. The increase was statistically significantly different from placebo [P < 0.001] group. After 1 year total hip BMD increased significantly by 4.5%.Treatment of postmenopausal Osteoporosis by interval IV bolus injections of the bisphosphonate Ibandronateis an effective and convenient way of increasing BMD at hip and spine. The high potency of Ibandronate allows 3-month interval bolus IV injections as a new therapeutic approach with optimal compliance